I want to be a Cardiac surgeon

[hardworkDream]

Hey all, first-time user poster on sdn - I followed the forum throughout undergrad and med school

I matched 2018 into Gen surg program at a smaller mid-west program. Its a normal 5yr program, which allow years for research but hold it mostly responsible to the student to find funding. I would have done an I6, but honestly, just didn't have the scores. I want to emphasize - I am very happy and proud to be part of my program as it was my top choice!

Started on my service already and I know this is what I want. I want to pursue CT 100% and -IF- I change my mind I will deal with it at that point.

Basically, I want to make myself as competitive as possible to get into the best program I can. Ive began the obvious of reading/studying for ABSITE/ and have an idea of my STEP3 schedule. I will talk to the (1) thoracic surgeon at my program for advice/help, and will definitely try to jump into research.

Is there anything else I can do?

Any advice on avenues to get into research - is asking the doctor around here the best way?
I never had a publication, or abstract, but I did have some poster presentations in medschool - so my research background is limited. I am definitely interested in clinical research though.

As of now, congenital cardiac is a dream of mine (if people wanted to know my end goal), but first thing first, I want to get into a cardiac/CT fellowship.

Any and all advice is appreciated. Just trying to be proactive and start early - learn from the mistake I made in medschool being too passive about my future.

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[doc05]

if you're 100% dedicated to CT, then why on earth would you choose to train at a general surgery program that only has 1 thoracic surgeon?

 

[hardworkDream]

if you're 100% dedicated to CT, then why on earth would you choose to train at a general surgery program that only has 1 thoracic surgeon?

Sorry for poor wording. My hospital has 2 thoracic surgeons. We also rotate at other hospitals with other cardiac/thoracic surgeons

I just had 1 thoracic surgeon that I really felt comfortable with and felt I could talk to as an intern at the time.

-Update- I've learned a lot now that intern year is done. And my mentor has been convincing me to purse thoracic, somewhat successfully. I still have cardiac on my mind (and he understands), but have been really enjoying thoracic. Regardless, just some things I learned which may help others that take a glance here:

Besides the obvious 3: Absite, LOR, research
-I've learned how important networking is. Just reaching out and emailing other CT surgeons in the area and asking to work with them on my days offs helped me a lot. You might not get hands on, but a lot can be gained by observing, and meeting other residents/fellows.
-Doing your best in residency + being a team player; I have been able to establish some great relationships with my attendings (might help with LORs). My fellow residents and some attendings invited me onto research projects. My quiz scores could still be better, but I have been making some small improvements.

And a personal note from me for anyone who wants it. My mindset at the time of the post was that I was drowning that first month. I think I felt like I had no one to reach out to. Maybe part of the reason I turned to this forum. I probably felt safe in anonymity. As a personal reflection and something to share that helped me intern year.

-Grinding: Perseverance is probably the best advice my former chief gave me. I felt I was the only one struggling, and that I was not good enough to be a great surgeon, or maybe even a average one. The constant criticism and lack of positive reinforcement for almost the entirety of intern year nearly got me. I had moments where I would wake up everyday thinking that I should quit, and try to find another specialty because I might have made the wrong choice; or that I just did not want to go into work because I was tired of being humiliated. I felt unwanted and unsupported by my program. I barely slept, my hygiene was horrible, I stopped exercising, my spirit was broken. I had high expectations for myself, and even if no one said anything, I felt I was performing badly. But, its the perspective to try and improve, set aside the ego, admit my faults, and grow - that helped me push through. I was scared to open up for fear of judgment. But, connecting with my fellow interns and some of my seniors about the struggles of residency helped me feel less alone. My mentor was key in reinvigorating my love for surgery. Its not a perfect ending though, and I still am grinding. Still feel constantly sleep deprived. Still feel inadequate at many things, however, I try my best to use it as motivation to get into the OR even if double-scrubbed, or study on down time. 10 questions a day is my mantra/motto (admittedly I don't adhere 100%, but get somewhat close). Day-by-day, things are getting a little better.

Anyways, I would still appreciate any advice to have a great application for CT fellowship. I'd love to hear any and all thoughts, opinions, or personal anecdotes.

 

[Dr.LeoSpaceman]

Just wanted to thank you for posting your follow-up. I think it can be helpful for people to see that there is a path forward. You should also be commended on how you've taken control of your own destiny. People get told that networking is important, and that they should put themselves out there, and that they just need to put their head down and work hard...but few actually do it.

It also strikes me how terrible residency sounds when described by someone going through it. Certainly not new, but it does give me pause. I'm often torn between the idea that "it shouldn't/doesn't have to be like this" and "it has to be like this to prepare people for the rigors of actually being an independent surgeon".

And just to let you know, those feelings of inadequacy don't go away. Nine years in, I still regularly deal with self-doubt despite getting positive external reinforcement from peers/mentors. I like to think that they help keep me grounded and avoid complacency.

 

[Medstart108]

Research is important, networking is key. A small field like cardiothoracic really values that. People talk and people know people. It's a small world and a lot can be done with just relationships.

 

[dienekes88]

Sort out funding and do some research. You should find a mentor. If you want to do cardiac surgery, especially congenital heart surgery, then you should find either a heart surgeon or a congenital heart surgeon to do your research. Sometimes the clinical mentor may not be the best research mentor, so you should recognize that you may need an additional research mentor.

At the end of the day, you just need to make yourself stand out on paper. Conceptually, it's not that complicated, but making it happen... that's where it becomes difficult. The top level applicants are very impressive. Just look around at the fellows or first/second year faculty members at big programs and pubmed them to see how many publications they probably had starting fellowship, and you'll see that most (not all) are very impressive candidates.

Congenital is a very small field. Getting yourself out there to meet people will be very important. Training at a cardiothoracic residency with a bigger congenital program is important, but you may want to even consider going to a place that has an associated ACGME fellowship, which is not many of them.

 

[Medstart108]

I think a field like thoracic or adult cardiac is very achievable. Congenital is a whole different beast. Average of 3 jobs a year across the entire US. High standards, this has to be your life's mission full stop. People who want to do congenital take at least 2 or more years usually to do research. Highly technical field as well as a very challenging field to break into. Job market will never be good in congenital.

 

[Mizuno]

Sorry for poor wording. My hospital has 2 thoracic surgeons. We also rotate at other hospitals with other cardiac/thoracic surgeons

I just had 1 thoracic surgeon that I really felt comfortable with and felt I could talk to as an intern at the time.

-Update- I've learned a lot now that intern year is done. And my mentor has been convincing me to purse thoracic, somewhat successfully. I still have cardiac on my mind (and he understands), but have been really enjoying thoracic. Regardless, just some things I learned which may help others that take a glance here:

Besides the obvious 3: Absite, LOR, research
-I've learned how important networking is. Just reaching out and emailing other CT surgeons in the area and asking to work with them on my days offs helped me a lot. You might not get hands on, but a lot can be gained by observing, and meeting other residents/fellows.
-Doing your best in residency + being a team player; I have been able to establish some great relationships with my attendings (might help with LORs). My fellow residents and some attendings invited me onto research projects. My quiz scores could still be better, but I have been making some small improvements.

And a personal note from me for anyone who wants it. My mindset at the time of the post was that I was drowning that first month. I think I felt like I had no one to reach out to. Maybe part of the reason I turned to this forum. I probably felt safe in anonymity. As a personal reflection and something to share that helped me intern year.

-Grinding: Perseverance is probably the best advice my former chief gave me. I felt I was the only one struggling, and that I was not good enough to be a great surgeon, or maybe even a average one. The constant criticism and lack of positive reinforcement for almost the entirety of intern year nearly got me. I had moments where I would wake up everyday thinking that I should quit, and try to find another specialty because I might have made the wrong choice; or that I just did not want to go into work because I was tired of being humiliated. I felt unwanted and unsupported by my program. I barely slept, my hygiene was horrible, I stopped exercising, my spirit was broken. I had high expectations for myself, and even if no one said anything, I felt I was performing badly. But, its the perspective to try and improve, set aside the ego, admit my faults, and grow - that helped me push through. I was scared to open up for fear of judgment. But, connecting with my fellow interns and some of my seniors about the struggles of residency helped me feel less alone. My mentor was key in reinvigorating my love for surgery. Its not a perfect ending though, and I still am grinding. Still feel constantly sleep deprived. Still feel inadequate at many things, however, I try my best to use it as motivation to get into the OR even if double-scrubbed, or study on down time. 10 questions a day is my mantra/motto (admittedly I don't adhere 100%, but get somewhat close). Day-by-day, things are getting a little better.

Anyways, I would still appreciate any advice to have a great application for CT fellowship. I'd love to hear any and all thoughts, opinions, or personal anecdotes.

-Networking is key. Like someone said before, CT surgery is a very small world and going to CT conferences (STS or AATS) will help. You want to solidify your relationship with the CT surgeons, so they can write you a good letter or even pick up the phone for you.
-Do well on the in-service exam, don't try to haggle with people and say that ohhh 70th percentile is pretty good, just dominate and make 90+ so it's a non-issue
-be a good/great resident, the kind that people say, damn I'm happy when he/she is on my service
-if you do well on the exam and are a good resident, then you will naturally get good letters
-have some research, so your CV doesn't look barren

 

[hardworkDream]

I was reading through the forum about the current Thoracic Fellowship application and stumbled upon my old post. So if it helps anyone, I will post a update again. (Post turned out much longer than intended.)

-Update-

I am applying to thoracic surgery fellowship this year as a PGY-4 Gen Surg resident. I'll post some thoughts for anyone who finds it to be helpful. Its not to brag about myself, but merely as insight as to what it took for me.

In some sense, I am close to the finish line and in others I am about to begin. I have grown beyond what I thought possible through my general surgery residency. I re-read my second post, and it brought back some memories I had forgotten about. I nearly forgot how difficult residency truly felt. I know residency has been hard and I do recall tough times, but I suppose I forgot how overwhelming the struggle felt. My perspective has changed 180 from that time. Attendings who I felt hated me and took me for an idiot are my biggest mentors and friends. If you told me as an intern that I can converse and behave with them like a colleague, I would never have believed it. I realize now that they had set an incredibly high expectation for me, and put forth the effort to get me there. From my eyes, I was always being "graded". I was visualizing a sort of "pass/fail" mentality rather than a growth and improvement mindset. Now that I am on a teaching end as a senior resident, I understand how much effort and energy it take to teach someone. Its not easy to be an educator when your bottom-line is always patient care first. A key piece of advice for me was to take the focus off of myself, my performance, my ego, and focus it on the patient and patient care. It might seem obvious, but it helped me in many ways.

I think one of the changes that occurred was when I completed my service as the senior resident running my chair's and program director's services, as well as the trauma service. Its a grueling stretch where you bust your literal ass off working as hard as you can. Paying attention to all the details so patients do not slip through the cracks, but keeping in mind the big picture of the patient's overall course. All while, your managing the team of residents and PAs/NPs, organizing OR schedules, and ensuring the service runs with minimal hiccups. I requested an end-of-service review with my chair, vice chair, and PD. The reviews (for the first time in my residency) were glowing. I'll never forget my chair calling me a "superstar". He stated I had earned his respect. I nearly cried after I left the room. To put it in perspective, at the end of my intern year, we undergo a review of ACGME quality metric data of all the residents in the program. I was rated the worst in my program. We had 1 prelim quit and the other we fired. I was rated lower then them. My chair said he had questions about me graduating the program during my PGY-2 year, saying I didn't have what it takes at my current state. My PD said I was at an mediocre in the OR during my PGY-3 year. I kept my head down, took the criticism for critique, and worked on improving what I could.

I cant imagine many other experiences like residency. One of my co-resident said it was similar to his high school/college football experience, and my trauma attending stated it was similar to his initiation into the marines. Regardless, residency is a grind. You develop grit. You consistently polish yourself everyday, seriously, everyday. You expand your knowledge base to more than you would believe. The late nights studying, and re-studying topics you had gone over and over finally begin to take hold. You begin connecting patients and disease processes you have managed before (until you get humbled again). I always remembered being in awe of my seniors and chiefs. I didn't understand how they could know so much. I am now on the other side of that coin to my interns and juniors. I always try to encourage them cause for me, self-doubt was difficult to overcome, and still kind of is.. but to a lesser extent, maybe?

I also wanted to say I appreciate the advice I received here along the way. It was comforting to hear words from you all and special thanks to @Dr.LeoSpaceman . It really meant alot.

Anyways, enough of my rant. I'll post some of my stats so people can have a gauge of what I applied with to Thoracic Fellowship 2023 Start Date.

My program is a 5-year training program. I think we call it a "hybrid" program. I'm not exactly sure, but its a supposedly a mix of academic and community. My ABSITE 1/2/3rd year percentile scores are 30/68/82, 4th year pending. I got 5 LOR, 3 from CT surgeons, 1 from my PD and 1 from my chair. FYI, ERAS only allows 4 LOR max for each program. I was recommended to have at least 1 from PD or chair, and 2 from CT surgeons. I have 3 total projects: 1 oral presentation at a national meeting, 1 abstract, and part of a journal publication (3rd author). Interview season is underway right now for thoracic. I heard apparently ~180 applicants this year for ~60ish participating programs. Unsure how many spots. I received 18 interviews. A bit nervous, but looking forward to it. I hope you all can wish me good luck.

 

[harrdworrk]

I was reading through the forum about the current Thoracic Fellowship application and stumbled upon my old post. So if it helps anyone, I will post a update again. (Post turned out much longer than intended.)

-Update-

I am applying to thoracic surgery fellowship this year as a PGY-4 Gen Surg resident. I'll post some thoughts for anyone who finds it to be helpful. Its not to brag about myself, but merely as insight as to what it took for me.

In some sense, I am close to the finish line and in others I am about to begin. I have grown beyond what I thought possible through my general surgery residency. I re-read my second post, and it brought back some memories I had forgotten about. I nearly forgot how difficult residency truly felt. I know residency has been hard and I do recall tough times, but I suppose I forgot how overwhelming the struggle felt. My perspective has changed 180 from that time. Attendings who I felt hated me and took me for an idiot are my biggest mentors and friends. If you told me as an intern that I can converse and behave with them like a colleague, I would never have believed it. I realize now that they had set an incredibly high expectation for me, and put forth the effort to get me there. From my eyes, I was always being "graded". I was visualizing a sort of "pass/fail" mentality rather than a growth and improvement mindset. Now that I am on a teaching end as a senior resident, I understand how much effort and energy it take to teach someone. Its not easy to be an educator when your bottom-line is always patient care first. A key piece of advice for me was to take the focus off of myself, my performance, my ego, and focus it on the patient and patient care. It might seem obvious, but it helped me in many ways.

I think one of the changes that occurred was when I completed my service as the senior resident running my chair's and program director's services, as well as the trauma service. Its a grueling stretch where you bust your literal ass off working as hard as you can. Paying attention to all the details so patients do not slip through the cracks, but keeping in mind the big picture of the patient's overall course. All while, your managing the team of residents and PAs/NPs, organizing OR schedules, and ensuring the service runs with minimal hiccups. I requested an end-of-service review with my chair, vice chair, and PD. The reviews (for the first time in my residency) were glowing. I'll never forget my chair calling me a "superstar". He stated I had earned his respect. I nearly cried after I left the room. To put it in perspective, at the end of my intern year, we undergo a review of ACGME quality metric data of all the residents in the program. I was rated the worst in my program. We had 1 prelim quit and the other we fired. I was rated lower then them. My chair said he had questions about me graduating the program during my PGY-2 year, saying I didn't have what it takes at my current state. My PD said I was at an mediocre in the OR during my PGY-3 year. I kept my head down, took the criticism for critique, and worked on improving what I could.

I cant imagine many other experiences like residency. One of my co-resident said it was similar to his high school/college football experience, and my trauma attending stated it was similar to his initiation into the marines. Regardless, residency is a grind. You develop grit. You consistently polish yourself everyday, seriously, everyday. You expand your knowledge base to more than you would believe. The late nights studying, and re-studying topics you had gone over and over finally begin to take hold. You begin connecting patients and disease processes you have managed before (until you get humbled again). I always remembered being in awe of my seniors and chiefs. I didn't understand how they could know so much. I am now on the other side of that coin to my interns and juniors. I always try to encourage them cause for me, self-doubt was difficult to overcome, and still kind of is.. but to a lesser extent, maybe?

I also wanted to say I appreciate the advice I received here along the way. It was comforting to hear words from you all and special thanks to @Dr.LeoSpaceman . It really meant alot.

Anyways, enough of my rant. I'll post some of my stats so people can have a gauge of what I applied with to Thoracic Fellowship 2023 Start Date.

My program is a 5-year training program. I think we call it a "hybrid" program. I'm not exactly sure, but its a supposedly a mix of academic and community. My ABSITE 1/2/3rd year percentile scores are 30/68/82, 4th year pending. I got 5 LOR, 3 from CT surgeons, 1 from my PD and 1 from my chair. FYI, ERAS only allows 4 LOR max for each program. I was recommended to have at least 1 from PD or chair, and 2 from CT surgeons. I have 3 total projects: 1 oral presentation at a national meeting, 1 abstract, and part of a journal publication (3rd author). Interview season is underway right now for thoracic. I heard apparently ~180 applicants this year for ~60ish participating programs. Unsure how many spots. I received 18 interviews. A bit nervous, but looking forward to it. I hope you all can wish me good luck.

What an amazing story. MS2 here hoping to go for I6 or gen surg->ct fellowship. Been following your story since I was a premed! You inspired me man!!

 

[penangkia]

What an amazing story. MS2 here hoping to go for I6 or gen surg->ct fellowship. Been following your story since I was a premed! You inspired me man!!

What an amazing story! I hope you matched!

 

[hardworkDream]

Yes! Matched

 

[Nsec]

Congratulations on matching! Any advice you'd give to an intern thinking of applying to CT on how to prepare their application?

 

[hardworkDream]

Congratulations on matching! Any advice you'd give to an intern thinking of applying to CT on how to prepare their application?

Sorry for the very delayed response. Others have mentioned in the post previously and nothing I say here will add much, but heres my perspective...

Probably the most important is doing well in residency. Specifically, on your thoracic rotation whether cardiac or general. My mentor made phone calls and I think that is what made the biggest difference in terms of places I interviewed at. he really vouched for me. The thoracic world is fairly well connected and people know each other.

I think what helped me get interviews was doing well on ABSITE, particularly my 3rd year. As you saw from my first year I did not do well. So don't fret. I got 97th percentile my fourth year which wasn't available during applications but I was able to bring up during interviews and sent to places that requested them or I was very interested in. A few people commented on that.

In terms of research, I definitely didn't stand out. No one really asked me much about it. The more you have, the better.

Honestly, focus on learning surgery and doing well to gain a much as you can. As hard as residency is, you will never really have a chance like it again. Even in fellowship where I have a very large group of Thoracic attendings, it's a fraction in terms of the # of attendings i worked with in residency. There is so much experience and wisdom you can gain from all your attendings. I had my own struggles with residency but looking back I greatly benefited personally from it. I know it's not everyone's case but this is my opinion. Focus on the grind and your hard work will pay off. Constantly seek feedback and work on improving.

I wish you the best of luck! Please keep me posted